Infant, newborn Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(2):71-77
DOI 10.1590/S0100-72032013000200006
PURPOSE: To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. METHODS: A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. RESULTS: We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0‒28) and Gn median 0.5 (0‒25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2‒2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). CONCLUSION: In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(2):71-77
DOI 10.1590/S0100-72032013000200006
PURPOSE: To evaluate the anthropometric characteristics of morbidity and mortality of premature newborns (NB) of hypertensive mothers according to the presence or absence of flow (DZ) or reverse (DR) diastolic flow in the dopplervelocimetry of the umbilical artery. METHODS: A prospective study was conducted on preterm newborns of pregnant women with hypertension between 25 and 33 weeks of gestational age, submitted to umbilical artery Doppler study during the five days before delivery. Delivery occurred at Hospital Regional da Asa Sul, Brasília - Federal District, between November 1st, 2009 and October 31st, 2010. The infants were stratified into two groups according to the results of Doppler velocimetry: Gdz/dr=absent end-diastolic velocity waveform or reversed end-diastolic velocity waveform, and Gn=normal Doppler velocimetry. Anthropometric measurements at birth, neonatal morbidity, and mortality were compared between the two groups. RESULTS: We studied 92 infants, as follows: Gdz/dr=52 infants and Gn=40 infants. In Gdz/dr, the incidence of infants small for gestational age was significantly greater, with a relative risk of 2.5 (95%CI 1.7 - 3.7). In Gdz/dr, infants remained on mechanical ventilation for a longer time: median 2 (0‒28) and Gn median 0.5 (0‒25) p=0.03. The need for oxygen at 28 days was higher in G dz/dr comparing to Gn (33 versus 10%; p=0.01). Neonatal mortality was higher in Gdz/dr compared to Gn (36 versus 10%; p=0.03; relative risk of 1.6; 95%CI 1.2‒2.2). Logistic regression showed that, with each 100 grams lower birth weight, the chance of death increased 6.7 times in G dz/dr (95%CI 2.0 - 11.3; p<0.01). CONCLUSION: In preterm infants of mothers with hypertensive changes in Doppler velocimetry of the umbilical artery, intrauterine growth restriction and neonatal prognosis are often worse, with a high risk of death related to birth weight.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):20-26
DOI 10.1590/S0100-72032011000100003
PURPOSE: to evaluate associations between parental exposure to pesticides and births with congenital defects in São Francisco Valley, as well as the demographic profile and the defects found. METHODS: in this case-control study, each case (newborns with congenital defects) had two controls (healthy newborns). The subjects were born in the city of Petrolina, in São Francisco Valley, in 2009. The sample consisted of 42 cases and 84 controls. Data were gathered by a structured questionnaire adapted from Latin-American Collaborative Study of Congenital Malformations (ECLAMC), with the addition of questions related to exposure to pesticides, analysis of the medical records and contact with the hospital's pediatrician. The χ2 test was performed with a significance level of 5% to identify the variables with the greatest differences between case and control groups. Odds Ratio (OR) for the sample was calculated, as well as the OR obtained by logistic regression analysis, and finally, multivariate logistic regression analysis was performed. RESULTS: there was a greater exposure to pesticides during pregnancy in infants with congenital defects compared to healthy subjects. Increased risk was observed when at least one parent was exposed to pesticides (adjusted OR = 1.3; 95%CI = 0.4 - 3.9). The sociodemographic variables associated with congenital defects were: low school level, low weight, prematurity, young parents, chronic diseases, and physical factors. Multiple malformations and defects of the musculoskeletal and nervous systems were more frequently found. CONCLUSIONS: the present study suggests an association between exposure to pesticides and the occurrence of congenital defects, although the data were not significant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):20-26
DOI 10.1590/S0100-72032011000100003
PURPOSE: to evaluate associations between parental exposure to pesticides and births with congenital defects in São Francisco Valley, as well as the demographic profile and the defects found. METHODS: in this case-control study, each case (newborns with congenital defects) had two controls (healthy newborns). The subjects were born in the city of Petrolina, in São Francisco Valley, in 2009. The sample consisted of 42 cases and 84 controls. Data were gathered by a structured questionnaire adapted from Latin-American Collaborative Study of Congenital Malformations (ECLAMC), with the addition of questions related to exposure to pesticides, analysis of the medical records and contact with the hospital's pediatrician. The χ2 test was performed with a significance level of 5% to identify the variables with the greatest differences between case and control groups. Odds Ratio (OR) for the sample was calculated, as well as the OR obtained by logistic regression analysis, and finally, multivariate logistic regression analysis was performed. RESULTS: there was a greater exposure to pesticides during pregnancy in infants with congenital defects compared to healthy subjects. Increased risk was observed when at least one parent was exposed to pesticides (adjusted OR = 1.3; 95%CI = 0.4 - 3.9). The sociodemographic variables associated with congenital defects were: low school level, low weight, prematurity, young parents, chronic diseases, and physical factors. Multiple malformations and defects of the musculoskeletal and nervous systems were more frequently found. CONCLUSIONS: the present study suggests an association between exposure to pesticides and the occurrence of congenital defects, although the data were not significant.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):540-546
DOI 10.1590/S0100-72032009001100003
PURPOSE: to verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. METHODS: fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3%, respectively. CONCLUSIONS: in cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(11):540-546
DOI 10.1590/S0100-72032009001100003
PURPOSE: to verify the association between ultrasonographic signs during gestation and post-delivery evolution in fetuses with bilateral obstructive uropathies, followed up in an expectant way. METHODS: fetuses with bilateral obstructive uropathies presenting severe oligoamnios and narrow thorax have been compared with fetuses with bilateral obstructive uropathies without those alterations, concerning the presence or absence of cysts in both kidneys, and the presence or absence of parenchymal hyperechogenicity in both kidneys. Cases of neonatal death were compared with cases of neonatal discharge from the nursery, regarding the same renal echographic aspects mentioned above, the presence of severe oligoamnios and narrow thorax. The sensitivity, specificity, positive and negative predictive value of the presence of bilateral renal cysts, bilateral renal hyperechogenicity, severe oligoamnios and narrow fetal thorax for the neonatal death were calculated. RESULTS: severe oligoamnios and narrow thorax were more frequent (p=0.03; p<0.001) in fetuses with bilateral renal cysts, as compared to those with echographically normal renal parenchyma. Neonatal death was more frequent among cases with severe oligoamnios (p<0.001), narrow thorax (p<0.001) and bilateral renal cysts (p<0.002), when respectively compared with cases without those alterations. The best values of sensitivity, specificity, positive and negative predictive value for the death of neonatal/breastfeeding infants were obtained using the echographic aspect of narrow thorax, and were 81.8, 100, 100 and 79.3%, respectively. CONCLUSIONS: in cases of fetuses with bilateral obstructive uropathies followed up in an expectant way, the ultrasonographic signs more associated to bad prognosis are severe oligoamnios, narrow fetal thorax and presence of bilateral renal cysts.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(6):279-284
DOI 10.1590/S0100-72032009000600003
PURPOSE: to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. METHODS: cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. RESULTS: in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. CONCLUSIONS: neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(6):279-284
DOI 10.1590/S0100-72032009000600003
PURPOSE: to evaluate the effect of delivery type and usual obstetric procedures on the neurologic condition of a sample of consecutive term and healthy neonates, in the first 48 hours of life, using the Neurologic Adaptative Capacity Score (NACS) system. METHODS: cohort prospective study with 313 neonates, from a neonatology unit: Unidade de Neonatologia e Alojamento Conjunto. The variables analyzed were obstetric variables; clinical outcome: low neurologic vigor phase, evaluated by NACS, at 4, 24 and 48 hours of life. The data have been assessed twice: once with the whole sample and the other comparing the Vigorous Group, whose neonates kept a score of 35 or more during the three evaluations, and the Low Vigor Group, with less than 35 scores during the three consecutive evaluations. Bivariate and multivariate analyses have been done. Possible associations between low neurologic vigor phase and the type of delivery, as well between the low neurologic vigor phase and obstetric variables have been searched. RESULTS: in the bivariate analysis, the delivery type and the obstetric variables were not associated with the low neurologic vigor phase. Nevertheless, the association between the amniotic fluid and the low neurologic vigor phase reached values very close to significance and, then, it was included in the multivariate analysis. In the multivariate analysis, the only variable associated with low neurologic vigor was the presence of meconium stained amniotic fluid, which has shown to be 8.1 times more risky for the neurologic scoring, when Vigorous Group and Low Vigor Group were compared. In the analysis of the whole sample, the same risk was 1.7. CONCLUSIONS: neither the delivery type, nor the usual obstetric procedures were associated with low neurologic vigor phase. This is useful information, clinically or legally speaking, mainly for obstetricians. According to this sample data, when the term neonate is healthy, the delivery type and the usual obstetric procedures have no impact in the neurologic condition.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):5-9
DOI 10.1590/S0100-72032009000100002
PURPOSE: to evaluate factors related to the presence of neonatal macrosomia in pregnant women with gestational diabetes mellitus. METHODS: 157 pregnant women presenting gestational diabetes mellitus in follow-up were retrospectively selected from January 2004 to July 2006. This group has been divided into two subgroups: one with newborns with weight in accordance with the gestational age (n=136) and another with macrosomic newborns (n=21). Maternal characteristics have been compared between the groups. The t-Student test was used for the analysis of equality hypothesis between the averages of the two groups, and chi-square test, to check the groups' homogeneity concerning ratios. RESULTS: the groups did not show any significant difference concerning the gestational age, body mass index, weight gain along the gestation, number of previous pregnancies, fast glycemia in the oral glucose tolerance test after the ingestion of 75 g (TOTG 75 g), gestational age at delivery, glycemic values during the treatment, and the type of treatment used (p>0.05). In the group with neonatal macrosomia, there was a higher two-hour-glycemia in the TOTG 75 g (p=0.02), higher gestational age at the treatment onset (p=0.02), and a lower number of appointments at the health service (p<0.01). When adjusted to a logistic regression model, the most important factor (p<0.01) found to predict neonatal macrosomia was the two-hour-glycemia in the TOTG 75 g. CONCLUSIONS: the factors more frequently related to neonatal macrosomia were late treatment onset and, consequently, lower number of appointments and chiefly, high two-hour-glycemia in the TOTG 75 g.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):126-133
DOI 10.1590/S0100-72032007000300003
PURPOSE: to evaluate the impact of the nutritional status of pregnant adolescents on the birth weight. METHODS: a cohort study including 97 adolescents and their respective newborns, evaluated from May to June, 2004. Pregnant women from 10 to 19 years old in labor were included in the study, and those with multiple pregnancies, complications, less than 37 weeks gestation, and incomplete data records were excluded. Maternal nutritional status evaluation included height, body mass index (BMI) before pregnancy, gestational weight gain (GWG) and caloric-proteic intake, obtained by habitual food intake recordatory by the end of the third gestational trimester. The association between maternal variables (height, pre-gestational BMI, GWG and intake) and the newborn weight was analyzed by Spearman's correlation test. Statistical significance was assumed when p<0.05. RESULTS: the mean age was 17.8±1.12 years old. Most adolescents (66%) started pregnancy with adequate weight, 29% had low weight and 5% overweight. Most adolescents showed inadequate GWG, caloric and proteic intake. Low birth weight was recorded in 7% of the newborns and insufficient weight was recorded in 37% of them. Maternal height and GWG showed positive and significant BW relation. Pre-gestational BMI and protein intake showed statistically significant inverse correlation with birth weight. No correlation between caloric intake and BW was demonstrated. CONCLUSION: maternal height and GWG influence the newborn nutritional status.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(3):126-133
DOI 10.1590/S0100-72032007000300003
PURPOSE: to evaluate the impact of the nutritional status of pregnant adolescents on the birth weight. METHODS: a cohort study including 97 adolescents and their respective newborns, evaluated from May to June, 2004. Pregnant women from 10 to 19 years old in labor were included in the study, and those with multiple pregnancies, complications, less than 37 weeks gestation, and incomplete data records were excluded. Maternal nutritional status evaluation included height, body mass index (BMI) before pregnancy, gestational weight gain (GWG) and caloric-proteic intake, obtained by habitual food intake recordatory by the end of the third gestational trimester. The association between maternal variables (height, pre-gestational BMI, GWG and intake) and the newborn weight was analyzed by Spearman's correlation test. Statistical significance was assumed when p<0.05. RESULTS: the mean age was 17.8±1.12 years old. Most adolescents (66%) started pregnancy with adequate weight, 29% had low weight and 5% overweight. Most adolescents showed inadequate GWG, caloric and proteic intake. Low birth weight was recorded in 7% of the newborns and insufficient weight was recorded in 37% of them. Maternal height and GWG showed positive and significant BW relation. Pre-gestational BMI and protein intake showed statistically significant inverse correlation with birth weight. No correlation between caloric intake and BW was demonstrated. CONCLUSION: maternal height and GWG influence the newborn nutritional status.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):122-125
DOI 10.1590/S0100-72032006000200008
PURPOSE: to evaluate the prevalence of hemoglobin S (HbS) in newborns, through clinical investigation and laboratory data. METHODS: a protocol established the drawing of 10 mL blood from the umbilical cord after its ligature and section, immediately after birth. The samples were kept in a tube with 5% EDTA and then submitted to high-performance liquid chromatography. The study included a clinical record taken from an interview with the mother, her physical and biochemical condition, as well as that of her newborn. Main criteria were newborn's weight, sex, first minute Apgar, and the mother's color. Statistical analysis was based on the Epi-Info 6.0 program and performed by Student's t test, with the level of significance set at p<0.05. RESULTS: from August 2001 to September 2002, 389 umbilical cord blood samples showed HbS in 16 newborn babies (4.1%). Fifteen of these presented sickle-cell traits (HbS) and the other had a diagnostic hypothesis of sickle-cell anemia (HbSS). Hemoglobinopathy prevailed among male babies. No significant difference was observed between newborns with or without HbS regarding averages of weight and Apgar scores; the same occurred regarding the mother's skin color (Caucasians, mulattos and blacks). CONCLUSION: searching for hemoglobin diseases in newborns should be considered because of the possibility of 25% sickle-cell anemia in the offspring of couples with sickle-cell traits. Screening for abnormal hemoglobin is important in the population at risk. Thus, the creation of programs with these aims is recommended to be included in hospital routines.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(2):122-125
DOI 10.1590/S0100-72032006000200008
PURPOSE: to evaluate the prevalence of hemoglobin S (HbS) in newborns, through clinical investigation and laboratory data. METHODS: a protocol established the drawing of 10 mL blood from the umbilical cord after its ligature and section, immediately after birth. The samples were kept in a tube with 5% EDTA and then submitted to high-performance liquid chromatography. The study included a clinical record taken from an interview with the mother, her physical and biochemical condition, as well as that of her newborn. Main criteria were newborn's weight, sex, first minute Apgar, and the mother's color. Statistical analysis was based on the Epi-Info 6.0 program and performed by Student's t test, with the level of significance set at p<0.05. RESULTS: from August 2001 to September 2002, 389 umbilical cord blood samples showed HbS in 16 newborn babies (4.1%). Fifteen of these presented sickle-cell traits (HbS) and the other had a diagnostic hypothesis of sickle-cell anemia (HbSS). Hemoglobinopathy prevailed among male babies. No significant difference was observed between newborns with or without HbS regarding averages of weight and Apgar scores; the same occurred regarding the mother's skin color (Caucasians, mulattos and blacks). CONCLUSION: searching for hemoglobin diseases in newborns should be considered because of the possibility of 25% sickle-cell anemia in the offspring of couples with sickle-cell traits. Screening for abnormal hemoglobin is important in the population at risk. Thus, the creation of programs with these aims is recommended to be included in hospital routines.